ELDER TIP Older patients may ignore bowel symptoms, believing that they result from constipation, poor diet, or hemorrhoids. Evaluate your older patient's responses to your questions carefully.
On the right side of the colon (which absorbs water and electrolytes), early tumor growth causes no signs of obstruction because the tumor tends to grow along the bowel rather than surround the lumen, and the fecal content in this area is normally liquid. It may, however, cause black, tarry stools; anemia; and abdominal aching, pressure, or dull cramps. As the disease progresses, the patient develops weakness, fatigue, exertional dyspnea, vertigo and, eventually, diarrhea, obstipation, anorexia, weight loss, vomiting, and other signs or symptoms of intestinal obstruction. In addition, a tumor on the right side may be palpable.
On the left side, a tumor causes signs of an obstruction even in early stages because in this area stools are of a formed consistency. It commonly causes rectal bleeding (in many cases ascribed to hemorrhoids), intermittent abdominal fullness or cramping, and rectal pressure. As the disease progresses, the patient develops obstipation, diarrhea, or “ribbon” or pencil-shaped stools. Typically, he notices that passage of stools or flatus relieves the pain. At this stage, bleeding from the colon becomes obvious, with dark or bright red blood in the feces and mucus in or on the stools.
With a rectal tumor, the first symptom is a change in bowel habits, in many cases beginning with an urgent need to defecate on arising (morning diarrhea) or obstipation alternating with diarrhea. Other signs are blood or mucus in stools and a sense of incomplete evacuation. Late in the disease, pain begins as a feeling of rectal fullness that later becomes a dull, and sometimes constant, ache confined to the rectum or sacral region.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Gallbladder and bile duct cancer:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Clinically, gallbladder cancer is almost indistinguishable from cholecystitis — pain in the epigastrium or right upper quadrant, weight loss, anorexia, nausea, vomiting, and jaundice. However, chronic, progressively severe pain in an afebrile patient suggests malignancy. In patients with simple gallstones, pain is sporadic. Another telling clue to malignancy is palpable gallbladder (right upper quadrant), with obstructive jaundice. Some patients may also have hepatosplenomegaly.
Progressive profound jaundice is commonly the first sign of obstruction due to extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the epigastrium or the right upper quadrant, radiating to the back. Other common signs or symptoms, if associated with active cholecystitis, include pruritus, skin excoriations, anorexia, weight loss, chills, and fever.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Extramedullary tumors produce symptoms by pressing on nerve roots, the spinal cord, and spinal vessels; intramedullary tumors, by destroying the parenchyma and compressing adjacent areas. Because intramedullary tumors may extend over several spinal cord segments, their symptoms are more variable than those of extramedullary tumors.
The following clinical effects are likely with all malignant spinal cord neoplasms:
❑Pain — Most severe directly over the tumor, radiates around the trunk or down the limb on the affected side and is unrelieved by bed rest. It may worsen when lying down or with straining, coughing, or sneezing. Pain can be diffuse, occurring over all extremities. Generally, it progressively worsens and isn't relieved by medication.
❑ Motor symptoms — Asymmetric spastic muscle weakness, decreased muscle tone, exaggerated reflexes, and a positive Babinski's sign. If the tumor is at the level of the cauda equina, muscle flaccidity, muscle wasting, weakness, and progressive diminution in tendon reflexes are characteristic.
❑ Sensory deficits — Contralateral loss of pain, temperature, and touch sensation (Brown-Séquard's syndrome). These losses are less obvious to the patient than functional motor changes. Caudal lesions invariably produce paresthesias in the nerve distribution pathway of the involved roots.
❑Bowel and bladder symptoms — Urine retention is an inevitable late sign with cord compression. Early signs include incomplete emptying or difficulty with the urine stream, which is usually unnoticed or ignored. Cauda equina tumors cause bladder and bowel incontinence due to flaccid paralysis.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Multiple endocrine neoplasia:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Clinical effects of MEN may develop in various combinations and orders, depending on the glands involved. The most common manifestation of MEN I is hyperparathyroidism, followed by ulcer due to Zollinger-Ellison syndrome (marked by increased gastrin production from non-beta islet cell tumors of the pancreas). Hypoglycemia may result from pancreatic beta islet cell tumors, with increased insulin production. When MEN I affects the parathyroids, it produces signs of hyperparathyroidism, including hypercalcemia (because the parathyroids are primarily responsible for the regulation of calcium and phosphorus levels). When MEN causes pituitary tumor, it’s most commonly a prolactinoma, but can be a growth hormone or corticotropin, or even a nonsecretory adenoma.
Characteristic features of MEN II with medullary carcinoma of the thyroid include enlarged thyroid mass, with resultant increased calcitonin and, occasionally, ectopic corticotropin, causing Cushing’s syndrome. With tumors of the adrenal medulla, symptoms include headache, tachyarrhythmias, and hypertension; with adenomatosis or hyperplasia of the parathyroids, symptoms result from renal calculi.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Colorectal cancer:
Signs and symptoms
(Handbook of Diseases)
Signs and symptoms of colorectal cancer result from local obstruction and, in later stages, from direct extension to adjacent organs (bladder, prostate, ureters, vagina, sacrum) and distant metastasis (usually to the liver).
In the early stages, signs and symptoms are typically vague and depend on the anatomical location and function of the bowel segment containing the tumor. Later, they generally include pallor, cachexia, ascites, hepatomegaly, and lymphangiectasis.
Cancer on the right side
On the right side of the colon (which absorbs water and electrolytes), early tumor growth causes no signs of obstruction because the tumor tends to grow along the bowel rather than surround the lumen, and the fecal content in this area is normally liquid. It may, however, cause black, tarry stool; anemia; and abdominal aching, pressure, or dull cramps.
As the disease progresses, the patient develops weakness, fatigue, exertional dyspnea, vertigo and, eventually, diarrhea, obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction. In addition, a tumor on the right side may be palpable.
Cancer on the left side
On the left side, a tumor causes signs and symptoms of an obstruction even in early stages because in this area, stool is of a formed consistency. It commonly causes rectal bleeding (typically ascribed to hemorrhoids), intermittent abdominal fullness or cramping, and rectal pressure.
As the disease progresses, the patient develops obstipation, diarrhea, or “ribbon” or pencil-shaped stool. Typically, he notices that passage of stool or flatus relieves the pain. At this stage, bleeding from the colon becomes obvious, with dark or bright red blood in the stool and mucus in or on the stool.
Rectal tumor signs
With a rectal tumor, the first indication is a change in bowel habits, often beginning with an urgent need to defecate on arising (“morning diarrhea”) or obstipation alternating with diarrhea. Other indications include blood or mucus in stool and a sense of incomplete evacuation.
Late in the disease, pain begins as a feeling of rectal fullness that later becomes a dull and sometimes constant ache confined to the rectum or sacral region.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Gallbladder and bile duct cancers:
Signs and symptoms
(Handbook of Diseases)
Clinically, gallbladder cancer is almost indistinguishable from cholecystitis. The signs and symptoms of both disorders include pain in the epigastrium or right upper quadrant, weight loss, anorexia, nausea, vomiting, and jaundice. Chronic, progressively severe pain in an afebrile patient suggests cancer. With simple gallstones, the pain is sporadic.
Another telling clue to cancer is a palpable gallbladder (in the right upper quadrant) with obstructive jaundice. Some patients may also have hepatosplenomegaly.
Signs of bile duct cancer
Progressive, profound jaundice is commonly the first sign of obstruction caused by extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the epigastrium or right upper quadrant, radiating to the back. Other common symptoms, if associated with active cholecystitis, include pruritus, skin excoriations, anorexia, weight loss, chills, and fever.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Article Excerpts About Symptoms of Zollinger-Ellison syndrome:
Symptoms include signs of peptic ulcers: gnawing, burning pain in the
abdomen; diarrhea; nausea; vomiting; fatigue; weakness; and weight loss.
(Source: excerpt from Zollinger-Ellison Syndrome: NIDDK)
Zollinger-Ellison syndrome as a Cause of Symptoms or Medical Conditions
When considering symptoms of Zollinger-Ellison syndrome, it is also important to consider Zollinger-Ellison syndrome as a possible cause of other medical conditions.
The Disease Database lists the following medical conditions that Zollinger-Ellison syndrome may cause:
- (Source - Diseases Database)
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